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Objective: To explore the factors that encompass maternal self-efficacy in providing food for the home. Methods: In-depth interviews were conducted with 19 mothers of nutritionally at risk children in an urban area of East Jakarta, Indonesia. This study was based on Social Cognitive Theory, Family Stress Models, and Ecological Frameworks. Data collection was coded and analyzed using the Grounded Theory Method. Results: Most mothers felt secure in providing food for their families knowing that their relatives and neighbors would support them if they lacked the money to buy food; however, most of them did not supply appropriate meals in terms of nutrient content, variety, and timing. Conclusions and Implications: Maternal self-efficacy was mainly characterized by practical issues concerning the preparation of food at home and a lack of knowledge of health and nutrition. Family-based interventions are needed to enhance competence in providing nutritious food from available resources.

Background: Indonesia ranks fifth in terms of the number of stunted children and there has been little change in the stunting prevalence in the last decade. In earlier observational studies conducted in 2014-2015, we identified several key underlying problems with the potential to impact stunting in Sumedang district, West Java, Indonesia. Deficits in intakes of growth-limiting micronutrients were observed, most notably calcium, iron, zinc, and vitamin A, emphasizing the need for a food-based intervention to overcome these micronutrient deficits in the diets of mothers and their infants. Methods: A double-blind placebo-controlled cluster randomised trial comparing the effect of daily consumption of 75 grams of locally produced micronutrient-enriched crackers (MEC) (intervention group) compared to placebo crackers (control group) by mothers at two-time intervals: (i) from the 8-14 weeks of pregnancy to delivery (i.e., 28-34 weeks of consumption of MEC) on birth length, and (ii) from the 8-14 weeks of pregnancy to 5 months post-partum on attained linear growth and linear growth velocity of breast-fed infants. A total of 324 pregnant women from 28 clusters (villages) located in 3 sub-districts in Sumedang district, West Java, Indonesia, will be randomly assigned to either intervention (n=14 villages) or control (n=14 villages). Discussi on: This will be the first study in Indonesia to use crackers based on powdered eggshells and chicken liver, in a form which is acceptable, safe, and has a long shelf life. If daily consumption of MEC for 6 months during pregnancy can enhance birth length, or their continued daily consumption for 5 months postpartum improves both attained and incremental linear growth at 5 months of age, then scaling-up in Indonesia may be considered. Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04564222 ; 25 th September 2020.

Background Stunting and anemia in pregnant women and under-five children remain a challenge in developing countries, including Indonesia. One of the significant contributors to these problems is inadequate nutrient intake. Objectives The aim of the study was to identify, using a linear programming (LP) approach, problem nutrients and optimized food-based recommendations for under-five children and pregnant women in 10 stunting-prioritized districts in Indonesia. Methods LP analysis was done using the Optifood tool on dietary data collected using single 24-h dietary recall in the National Monitoring of Nutrient Consumption (Pemantauan Konsumsi Gizi), conducted by the Ministry of Health from 10 stunting-prioritized districts in Indonesia. Problem nutrients and nutrient-dense foods were identified, and all alternative food-based recommendations or complementary feeding recommendations were compared to identify which recommendation will best contribute to fulfill dietary adequacy. Results The number of problem nutrients in each district ranged from 0 to 7 nutrients for under-five children and 1 to 6 nutrients for pregnant women. The top 3 problem nutrients were: iron, zinc, and folate (for children aged 6–11 mo); zinc, folate, and calcium (for 12–23-mo-olds and 24–35-mo-olds); folate, zinc, and vitamin C/riboflavin (for 36–59-mo-olds); and iron, folate, and calcium (for pregnant women). The findings showed that problem nutrients identified using LP were in line with nutritional problems in under-five children (stunting and anemia) and pregnant women (anemia). Food-based recommendations (FBRs)/complementary feeding recommendations were developed that best meet dietary adequacy for the nutrients. Conclusions Despite the similarity in stunting prevalence across the districts, there was variation in number and types of problem nutrients. The developed FBRs that promoted nutrient-dense foods suited to the problem nutrients in each area need to be promoted to improve nutrient intakes of under-five children and pregnant women in these areas with high stunting prevalence. [ABSTRACT FROM AUTHOR]

Background: Complementary feeding recommendations (CFRs) with the use of locally available foods can be developed by using linear programming (LP). Although its potential has been shown for planning phases of food-based interventions, the effectiveness in the community setting has not been tested to our knowledge. Objective: We aimed to assess effectiveness of promoting optimized CFRs for improving maternal knowledge, feeding practices, and child intakes of key problem nutrients (calcium, iron, niacin, and zinc). Design: A community-intervention trial with a quasi-experimental design was conducted in East Lombok, West Nusa Tenggara Province, Indonesia, on children aged 9-16 mo at baseline. A CFR group (n = 240) was compared with a non-CFR group (n = 215). The CFRs, which were developed using LP, were promoted in an intervention that included monthly cooking sessions and weekly home visits. The mother's nutrition knowledge and her child's feeding practices and the child's nutrient intakes were measured before and after the 6-mo intervention by using a structured interview, 24-h recall, and 1-wk food-frequency questionnaire. Results: The CFR intervention improved mothers' knowledge and children's feeding practices and improved children's intakes of calcium, iron, and zinc. At the end line, median (IQR) nutrient densities were significantly higher in the CFR group than in the non-CFR group for iron [i.e., 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal) compared with 0.5 mg/100 kcal (0.4-0.7 mg/100 kcal)] and niacin [i.e., 0.8 mg/100 kcal (0.5-1.0 mg/100 kcal) compared with 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal)]. However, median nutrient densities for calcium, iron, niacin, and zinc in the CFR group (23, 0.6, 0.7, and 0.5 mg/100 kcal, respectively) were still below desired densities (63, 1.0, 0.9, and 0.6 mg/100 kcal, respectively). Conclusions: The CFRs significantly increased intakes of calcium, iron, niacin, and zinc, but nutrient densities were still below desired nutrient densities. When the adoption of optimized CFRs is constrained by economic access for or acceptability of nutrient-dense foods, other strategies need to be incorporated into interventions to ensure adequate intakes of these nutrients. The trial was registered at clinicaltrials.gov as NCT02078271. [ABSTRACT FROM AUTHOR]

Background. Iron deficiency is still the major nutritional problem in the developing world, and iron supplementation remains one of the most effective intervention strategies. Hepcidin, a newly discovered iron regulatory hormone, is an acute phase protein, and its role in iron supplementation has not been well explored. Objective. To investigate the hepcidin profiles of anemic adolescent girls who had received weekly iron supplementation. Methods. A cross-sectional study was conducted at the end of iron supplementation among adolescent schoolgirls (n = 83) in Pramuka Island, Indonesia. All the girls were anemic at the beginning and received 60 mg of elemental iron twice weekly for 12 weeks. Hemoglobin, hepcidin, serum ferritin, and red cell parameters were measured, together with inflammation markers. Results. At the end of the 12-week supplementation, 65.1% (n=64) of the girls were no longer anemic, but 43.4% (n = 36) were still iron deficient. The rate of subclinical inflammation, measured by C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), was 38.6% (n = 32). Hepcidin was not correlated with either ferritin or red cell parameters. There was no association between hepcidin and the inflammatory markers CRP and AGP. The mean hepcidin concentration was 42.9 ± 17.9 ng/mL and was not significantly different between anemic and nonanemic girls (44.2 ± 14.9 and 42.3 ± 19.2 ng/mL, respectively; p = .708). However, hepcidin concentration was slightly higher in the iron replete-group than in the iron-deficient group (45.2 ± 20.0 and 39.3 ± 13.5 ng/mL, respectively), a suggestive trend that did not reach statistical significance (p = .218). Conclusions. Hepcidin concentrations tended to be higher among the subset of girls who responded poorly to iron supplementation as a consequence of increased subclinical inflammation. A longitudinal study should be conducted to explore the role of hepcidin in iron supplementation. [ABSTRACT FROM AUTHOR]

Dietary Guidelines are sets of advisory statements that give dietary advice for population to promote nutritional well-being. They contain information on foods or behaviors that are encouraged and cautionary messages derived from scientific evidence-based reviews and specific local conditions. The Indonesian Dietary Guidelines consisting of 13 messages that were publicized by the Ministry of Health in 1995 and have not been reviewed afterward in relation to nutritional status and health outcome of the population. By reviewing studies on different age groups in the past 10 years and comparing the results with the recommended guidelines, this paper aims to identify if messages have been successfully applied and if there are relevant issues not yet covered in the guidelines. The reviews covered 29 out of 33 provinces, representing studies from sub-district or higher levels (district, provincial, national). Results showed that some messages have been better implemented than others: also that information for some messages was not available for which to conclude of its implementation. In addition, some practices were identified which are prevalent in several age groups and have important public health consequence, but not yet included in the 13-guidelines. These include: smoking, increased intakes of fruit and vegetables, limited intakes of salt and sugar, increased intakes of foods rich in zinc and calcium (besides iron), hand-washing before food preparation and eating, and weight-monitoring. For infants and young children, nutrient density, feeding responsiveness and stimulation should be specifically highlighted. Based on the results, several recommendations in revising the guidelines were given. [ABSTRACT FROM AUTHOR]

The food security assessment used by the United State's Food Security/Hunger Survey Module (US- FSSM) was used in five studies: these were in two urban and four rural areas in Indonesia between February 2004 - August 2005. The number of households assessed was 3,704 and consisted of 45% urban and 55% rural. All households had children below five years. This paper aims to assess the applicability of US-FSSM for measuring household food-insecurity in Indonesia. Common coping-strategies discussed are to borrow money from the family, get an additional job, to lessen portion size of food, and to sell small assets. Although households in urban and rural areas were similar in size/number of children and male headed; the urban households were more income-secure, educated, and had better access to electrical appliances. A majority of the households was food-insecure (77% and 84% in urban and rural consecutively). More food-insecure households without and with hunger were found in rural areas. The number of affirmative responses to 17 out of 18 questions in the US-FSSM was more in the rural households, showing less fortunate cases of food-insecurity. For a given coping strategy, as food-security status becomes more severe, the higher the percentage of households employing it. For a given food-security status, percentage of households was higher among lower-degree and less among higher-degree coping. Combining food-security and coping-strategy indicators may help to identify transient-food- secure households. Observing both indicators throughout different time of the year continuously may further identify adaptive mechanism by chronic-food-insecure households. Information on household food diversity could enrich findings on dietary intake modification, hence moving from food-security to nutrition-security. [ABSTRACT FROM AUTHOR]

Nutrition has been known as a predominant factor associated with stunting. However, some studies have discovered a genetic contribution in calcium absorption that will affect growth, known as the VDR gene. The aim of this study was to assess the association between VDR gene polymorphism and dietary intake towards height-for-age z-score (HAZ) of elementary school children in Malang District, East Java. This study analyzed the baseline of a randomized trial in East Java, Indonesia. School children aged 8–10 years old (n = 142) were included in this study. Energy, protein, calcium, and vitamin D intakes were obtained using 4-day 24-h dietary recalls. Two SNPs located in the promoter region of VDR gene were selected (rs11568820 and rs4516035) and analyzed using Real-Time PCR. The result showed a significant correlation between energy and protein intake with HAZ of the children (p = 0.030 and p = 0.016, respectively). The association between VDR gene and HAZ was not found (p > 0.05). Adjusted by other factors, protein intake was significantly correlated with HAZ (β = 0.034, 95% CI 0.015–0.052, p < 0.001, adj. R2 = 0.089). The children in our study had a favorable VDR gene genotype, however the effect of VDR gene promoter activity might not be revealed due to very low vitamin D and calcium intake to stimulate intestinal calcium absorption which in turn affects HAZ. [ABSTRACT FROM AUTHOR]

The need for a multisectoral approach to tackle stunting has gained attention in recent years. Baduta project aims to address undernutrition among children during their first 1000 days of life using integrated nutrition-specific and nutrition-sensitive interventions. We undertook this cohort study to evaluate the Baduta project's effectiveness on growth among children under 2 years of age in two districts (Sidoarjo and Malang Districts) in East Java. Six subdistricts were randomly selected, in which three were from the intervention areas, and three were from the control areas. We recruited 340 pregnant women per treatment group during the third trimester of pregnancy and followed up until 18 months postpartum. The assessment of breastfeeding and complementary feeding practices used standard infant and young child feeding (IYCF) indicators in a tablet-based application. We measured weight and length at birth and every three-months after that. The enumerators met precision and accuracy criteria following an anthropometry standardization procedure. Among the breastfed children, the percentage of children who achieved the minimum dietary diversity score (DDS) and minimum acceptable diet (MAD) was higher for the intervention group than the comparison group across all age groups. The odd ratios were 3.49 (95% CI: 2.2–5.5) and 2.79 (95% CI: 1.7–4.4) for DDS and 3.49 (95% CI: 2.2–5.5) and 2.74 (95% CI: 1.8–5.2) for MAD in the 9–11 month and 16–18-month age groups, respectively. However, there was no significant improvement in growth or reduction in the prevalence of anemia. The intervention was effective in improving the feeding practices of children although it failed to show significant improvement in linear growth of children at 18 months of age. [ABSTRACT FROM AUTHOR]

Dietary intake data are crucial for developing or evaluating nutrition interventions to improve the nutritional status of populations. The collection of accurate and reliable dietary data in developing countries, however, remains challenging. The emergence of new technologies, which facilitate electronic data capture, might address some of these challenges. This paper aims to describe an application developed to collect a multiple-pass 24-h dietary recall, using electronic data capture, and compare the results to those estimated using a paper-based method. In this study, a tablet-based application was developed, in the CommCare platform, to evaluate the effectiveness, for improving dietary adequacy, of a package of behavior change interventions to reduce stunting and anemia among 6–23-month-old children in East Java, Indonesia (Baduta project). Dietary intakes of energy and nutrients were estimated using electronic data capture in the cohort study of the Baduta project (n = 680). We compared these results with those estimated using paper-based data capture in the project's end-line cross-sectional study (n = 2740). We found a higher percentage of children classified as acceptable energy reporters (reported energy intake within the 95% CI of Total Energy Expenditure) with the electronic data capture compared with paper-based data capture (i.e., 60.8%, 72.4% and 80.7% for 6–8-, 9–11- and 12–23-month-old children, respectively, vs. 40.9%, 56.9%, and 54.3%, respectively). The estimated mean energy and nutrient intakes were not significantly different between these dietary data capture methods. These results suggest dietary data collection, using a tablet-based application, is feasible and can improve the quality of dietary data collected in developing countries. [ABSTRACT FROM AUTHOR]

Multiple common variants in transmembrane protease serine 6 (TMPRSS6) were associated with the plasma iron concentration in genome-wide association studies, but their effect in young children where anemia and iron deficiency (ID) were prevalent has not been reported, particularly taking account of iron intake. This study aims to investigate whether TMPRSS6 SNPs (rs855791 and rs4820268) and iron intake are associated with a low iron and hemoglobin concentration in under-two-year-old children. The study analyzed the baseline of a randomized trial (NUPICO, ClinicalTrials.gov NCT01504633) in East Lombok, Indonesia. Children aged 6–17 months (n = 121) were included in this study. The multiple linear regressions showed that TMPRSS6 decreased serum ferritin (SF) by 4.50 g/L per copy minor allele (A) of rs855791 (p = 0.08) and by 5.00 μg/L per copy minor allele (G) of rs4820268 (p = 0.044). There were no associations between rs855791 and rs4820268 with soluble transferrin receptor (sTfR) and hemoglobin (Hb) concentration (rs855791; p = 0.38 and p = 0.13, rs4820268; p = 0.17 and p = 0.33). The finding suggests the need for further studies to explore whether the nutrient recommendation for iron should be based on genetic characteristics, particularly for children who have mutation in TMPRSS6. [ABSTRACT FROM AUTHOR]

Abstract: There is a paucity of analysed data on contents of minerals and phytate in Asian complementary foods. Thus, cereals and legumes (n=27) consumed by Indonesian infants were analysed for iron, zinc and calcium using flame Atomic Absorption Spectrophotometry and for phytate using high performance liquid chromatography (HPLC). Results (per 100g dry weight) showed unfortified cereals had lower concentrations of zinc (1.5–3.2mg/100g vs. 3.2–5.8mg/100g), iron (0.3–5.4mg/100g vs. 2.9–17.4mg/100g), calcium (5–48mg/100g vs. 41–926mg/100g) and phytate (hexa- and penta-inositol phosphates; 70–246mg/100g vs. 177–1042mg/100g) than legumes and lower phytate: mineral molar ratios. Tempe had the lowest concentration of phytate (236–366mg/100g vs. 763–1042mg/100g), and the lowest molar ratios of phytate: zinc (6.3–12.6 vs. 14.3–21.1) and phytate: iron (1.6–4.0 vs. 5.0–11.3) compared to other soybean products. Milling increased concentrations of iron and calcium in rice (1.2 vs. 0.4mg/100g, p=0.002; and 8.1 vs. 5.1mg/100g, p=0.029, respectively); but reduced zinc (1.6 vs. 1.7mg/100g, p=0.013). Boiling increased calcium concentrations in rice and rice flour (5.1–16.7mg/100g, p=0.004; and 8.1–31.4mg/100g, p<0.001, respectively); whereas frying decreased iron concentrations in tempe (13.3–6.1mg/100g, p=0.038). When expressed per infant portions, fortified cereals and tempe were the best sources of zinc, iron, and calcium, because of their relatively high mineral and low phytate contents. [Copyright &y& Elsevier]